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Foundations 2 > Unit 2- GI disorders > Flashcards

Unit 2- GI disorders Flashcards

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1
Q

endoscopy

A

•direct visualization of body cavities, tissues, and organs thru use of flexible, lighted tube
•used for diagnostic and therapeutic procedures..
-obtain specimens
-remove abnormalities
-cauterize bleeding ulcer

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2
Q

colonoscopy

A

•enter colonoscope thru anus to visualize rectum and all parts of the colon

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3
Q

EGD (esophagogastroduodenoscopy)

A

•enter thru mouth into esophagus, stomach, and duodenum

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4
Q

ERCP (endoscopic retrograde cholangiopancreatography)

A
  • thru mouth into biliary tree via duodenum

* used to visualize biliary ducts, gall bladder, liver, and pancreas

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5
Q

sigmoidoscopy

A

•scope shorter than colonoscope, allowing visualization of anus, rectum, and sigmoid colon

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6
Q

endoscopic procedure basics

A
  • NPO 6-8 hrs
  • avoid anticoags and NSAIDS prior
  • ensure return of gag reflex before giving food/fluid
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7
Q

endoscopic complications

A
  • oversedation
  • hemorrhage- tachy/cool/clammy/dizzy
  • aspiration
  • perforation of GI tract- tachy/pain/nv/fever
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8
Q

gastric analysis

A
  • measures HCl and pepsin content to evaluate gastric and duodenal ulcers
  • NPO 12 hrs prior
  • NG tube inserted to obtain samples
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9
Q

decreased gastric acid indicates

A

•cancer

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10
Q

increased gastric acid indicates…

A
  • Zollinger-Ellison syndrome

* duodenal ulcers

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11
Q

Zollinger-Ellison syndrome

A

•increased production of gastrin caused by tumors (gastrinomas) in pancreas and duodenum

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12
Q

gastrointestinal series

A
  • radiocraphic imaging of esophagus, stomach, and entire intestinal tract
  • may or may not use contrast
  • barium drink for UGI
  • barium enema for LGI
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13
Q

gastroesophageal reflux disease (GERD)

A
  • gastric content and enzyme back flow into esophagus

* causes irritation to esophageal tissue, which delays clearance and lead to further irritation

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14
Q

GERD causes

A
  • excessive relaxation of LES*
  • frequent abdominal distention from overeating or delayed emptying
  • increased abdominal pressure
  • medications that relax LES or cause gastric acid secretion
  • hyperemia, erosion
  • hiatal hernia
  • lying flat
  • stress
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15
Q

food that relax LES

A
  • fatty, fried
  • chocolate
  • caffeine
  • peppermint
  • spicy
  • tomatoes
  • citrus
  • etoh/tobacco
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16
Q

reasons for increased abdominal pressure

A
  • obesity
  • preggo
  • bending at waist
  • ascites
  • tight clothing
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17
Q

hiatal hernia

A
  • part of stomach sticks up into diaphragm

* causes LES displacement into thorax w/ delayed esophageal clearance

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18
Q

medications that cause GERD

A
  • PO contraceptives
  • calcium channel blockers (HTN)
  • nitrates (vasodilators)
  • NSAIDS
  • sedatives
  • anti-cholinergics
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19
Q

s/s of GERD

A
  • dyspepsia after eating
  • pain (relieved w/ anti-acids)
  • throat irritation/globus
  • atypical chest pain
  • pyrosis (heartburn)
  • increased flatus
  • eructation
  • tooth erosion
  • hoarseness
  • chronic cough (aspiration)
  • consistent symptoms
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20
Q

diagnostics of GERD

A
  • EGD
  • ambulatory esophageal pH monitoring
  • pt keeps food diary
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21
Q

24-hr ambulatory esophageal pH monitoring

A
  • small catheter placed thru nose and into distal esophagus
  • pH reading taken in relation to food, position, and activity
  • most accurate method for testing GERD
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22
Q

GERD tx

A
  • diet/lifestyle changes
  • medication
  • surgery
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23
Q

antiacids

A 
•increase pH of gastric contents
•deactivate pepsin
•buffer acids
•best given on empty stomach
•aluminum -> constipation
•magnesium -> diarrhea
*Sodium Bicarbonate, Maalox, Mylanta
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24
Q

histamine receptor antagonists

A
  • antagonize (block) production of histamine

* do not impact reflux as much as reduce acid production and promote healing of inflamed tissue

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25
proton pump inhibitors
•primary tx for GERD •long-acting inhibition of gastric acid by impacting proton pump of parietal cells in mucosa •given IV to treat/prevent stress ulcers *Prilosec, Zantac, Prevacid
26
long term use of proton pump inhibitors
* may mask symptoms * may cause pneumonias and C-diff * increase risk of hip fractures in elderly b/c of Ca2+ loss
27
complications of GERD
* aspiration of gastric secretions * Barrett's epithelium (premalignant) * esophageal adenocarcinoma
28
Barrett's epithelium
* tissue lining the esophagus changes to resemble tissue lining inside of intestine * caused by untreated GERD and esophageal exposure to acid/pepsin
29
esophageal varices
* swollen, fragile blood vessels in esophagus * often due to tobaccos and heavy alcohol intake * hemorrhage of varices has high mortality rate
30
gastritis
* inflammation of lining of stomach * scattered or localized * can be erosive and cause ulcers, increasing risk for stomach cancer * common causes are histamine release, HCl, and CN 10 stimulation
31
prostaglandins
* form protective layer over lining of stomach | * reduce gastric acid secretions
32
acute gastritis
* sudden onset/short duration * may result in gastric bleeding * caused by H. pylori, E. coli, salmonella * caused by NSAIDs and stress
33
acute gastritis s/s
* hematemesis * melena * dyspepsia * epigastric pain * anorexia * N/V
34
acute gastritis interventions
* diet/lifestyle changes * medication * transfusion if bleeding severe * fluid replacement * surgery
35
chronic gastritis
* slow onset | * may damage parietal cells -> pernicious anemia b/c B12 can't be absorbed
36
type A chronic gastritis
* r/t autoimmune response to parietal (acid-secreting) and intrinsic factor cells * genetic
37
type B chronic gastritis
•caused by H. pylori infection, which stimulates release of inflammatory cytokines
38
chronic gastritis s/s
``` *few unless ulceration present •vague epigastric pain (relieved by food intake) •anorexia •N/V •intolerance of fatty/spicy •pernicious anemia ```
39
chronic gastritis interventions
* test for H. pylori * find underlying cause (inflame. bowel, toxic sub., etc) * shilling test for pernicious anemia
40
drugs to avoid w/ gastritis
* corticosteroids * erythromycin * NSAIDS
41
Dumping syndrome
* vasomotor response to food ingestion due to stomach being no longer able hold contents and "dumping" mass amounts into small intestine * reduced circulatory volume b/c trying to supply intestines * s/s of tachycardia, hypotension, dizziness * compilation of GERD and PUD * high protein diet, avoiding wheat and dairy
42
peptic ulcer
•erosion of mucosal lining of stomach or duodenum •if eroded enough, epithelium exposed to gastric acid/pepsin, which leads to bleeding and perforation •3 types -gastric -duodenal -stress *most caused by H. pylori
43
location fo duodenal ulcers ulcers
* upper portion of duodenum | * evening pain 1.5-3 hrs after meal
44
stress ulcers
* gastric lesions as a result of medical crisis, stress, or trauma * Curling's ulcer- burn pt * Cushing's ulcer- increased ICP
45
gastric ulcers
* located in stomach | * have normal gastric acid secretion, but have delayed stomach emptying
46
most serious complications of PUD
* hemorrhage * perforation * pyloric obstruction
47
hemorrhage
* massive bleeding in form of hematemesis or melena | * can lead to shock (hypotension, tacky, dizzy, confusion) or decreased Hgb
48
hematemesis
•upper GI bleed, above duodenojejunal jxn •bright red blood in vomit *gastric acid digestion of blood appear like coffee grounds
49
melena
•dark red blood in tarry appearing stool
50
perforation
* deep ulcer goes thru lining of stomach or duodenum | * can cause peritonitis
51
perforation presentation
``` •severe epigastric pain spreading across abdomen •round, board-like abdomen •hyperactive or diminished bowel sounds •rebound tenderness *surgical emergency ```
52
pyloric obstruction
* pyloris at end of stomach is blocked due to stasis and gastric dilation * etiology is edema, scarring, and inflammation resulting from PUD
53
nursing interventions for GI bleeding
* ABCs * vital signs (prevent hypovolemic shock) * fld replacement * NG tube lavage * manage pain * admin meds
54
NG tube gastric lavage
* NS instilled and then removed with blood | * pt on L side to limit flow out of stomach
55
Why would a client with gastric ulcers need to be cautious about using OTC cold remedies?
* OTC medications may have aspirin in them * OTC medications may contain NSAIDs * Drug interactions may occur causing deepening of the stomach ulcers
56
why do NSAIDs cause bleeding
•inhibit prostaglandin production •prostaglandins are responsible for providing mucosal layer of stomach *nothing to protect stomach
57
Chronic gastritis can cause
* Pernicious anemia * Sickle cell anemia * Gastric ulcers * Electrolyte imbalance * Cancer of the stomach
58
role of parietal cells
* intrinsic factor that helps absorb B12 * destroyed in chronic gastritis * require B12 injection for life * also secrete HCl (diminished in older adult)
59
pt side postion to promote gastric emptying
* right | * gravity guides contents into bowel
60
GI changes in older adult
* atrophy of gastric mucosa (parietal cells) leads to decreased HCl, which leads to decreased absorption of iron and B12 * atrophic gastritis may occur as consequence of overgrowth of bacteria * increased risk of candidiasis d/t diminished immune function (diabetes, malnourished, and stress)
61
GERD in elderly
•may not have s/s of reflux b/c diminished parietal cell HCl production *more severe complications b/c immunocompromised •atypical chest pain •ENT infections; Barrett's esophagus •pulmonary symptoms •sleep apnea •asthma
62
pt side position to prevent GERD complications
•left side | *varies based on individual
63
The danger of aspiration is increased if regurgitation occurs when the client
•lying down
64
dysphagia indicates ____; and assessment by RN should include ____
* stricture of esophagus | * when it occurs in pt
65
interventions for antacid admin
* give on empty stomach * monitor for constipation * don't give w/ other drugs * assess pt for hx of HF or renal dz first

Foundations 2 (10 decks)

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